Novel and Emerging Pathological Factors in Localized and Recurrent Prostate Cancer

How to cite: Paner GP. Novel and Emerging Pathological Factors in Localized and Recurrent Prostate Cancer. Grand Rounds in Urology. September 15, 2025. Accessed Mar 2026 . https://grandroundsinurology.com/novel-and-emerging-pathological-factors-in-localized-and-recurrent-prostate-cancer-2/

Summary

Gladell P. Paner, MD, Professor of Pathology and Surgery (Urology), University of Chicago, Chicago, Illinois, explains emerging prostate cancer pathology factors and grading strategies. He discusses tumor patterns within contemporary Gleason pattern 4, emphasizing that cribriform glands are strongly associated with adverse outcomes and should always be reported in Gleason Grade Group (GG) 2 to GG 4 cancers.

Dr. Paner also highlights intraductal carcinoma of the prostate (IDCP), which often coexists with invasive cancer and predicts adverse outcomes. New joint recommendations from the International Society of Urological Pathology (ISUP) and Genitourinary Pathology Society (GUPS) state that IDCP should now be incorporated into cancer grading, upgrading tumors previously classified as GG1. Atypical intraductal proliferation (AIP), now termed “AIP suspicious for IDCP,” is reported as a potential marker of undersampled cancer and necessitates repeat biopsy.

Quantitative grading is explored, with a percent pattern 4 required in GG2 to GG3 cancers. Data suggest that ≤5% pattern 4 may not impact prognosis in GG2, supporting active surveillance. Millimeter quantification of pattern 4 may offer superior prognostic ability, though it is not yet routinely reported.

Dr. Paner reviews grading approaches with multiple positive biopsy cores. While clinicians often rely on the highest grade, global and composite grades may provide stronger correlation with index tumor biology, especially in multifocal disease. Alternative grading schemes, such as the cribriform grade and integrated quantitative Gleason score, are promising but require validation.

These novel pathological factors in prostate cancer, including cribriform glands, IDCP, and evolving grading strategies, may influence risk stratification and treatment decisions in localized and recurrent disease.

The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical cases and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.